Let’s talk about period pain

Around 95% of women experience period pain at some stage in their life, though the subject is rarely spoken about. Leela offers some direct discussion and helpful advice on how to manage this common occurrence.

Menstruation is natural – but for it to cause extreme pain isn’t. Around 95% of women experience period pain at some stage in their lifetime. Some may even suffer from period pain from their early teens right up to menopause. Most women experience some discomfort during menstruation, especially on their first day. Furthermore, in 40% of women, period pain is tied in with premenstrual symptoms, such as bloating, tender breasts, a swollen stomach, lack of concentration, mood swings, clumsiness, and tiredness.

But in 10-25 % of women the pain is severe enough to disrupt their life.

Period pain is the most common cause of absenteeism from school and work, resulting in a drop in academic performance, decreased participation in sport and social activities, and an overall decline in quality of life. As such, period pain appears to be the most common gynaecological disorder in women, irrespective of nationality and age.

In a recent survey [YouGov, 2017] 42% of women stated that their periods made it harder to do their jobs. 30% said their period pain was so bad they needed to take a day off work.

Yet, those who took time off weren’t likely to divulge the actual reason of their absence. Instead they blamed migraines, stomach pains, or other health issues. The reason for this was that they did not feel comfortable discussing their period pain with their boss.

It may not seem like a big issue to call up sick with a migraine instead of period pain. However, considering that this is a natural bodily process that happens every month, society is still surprisingly wary to talk about it. So, let’s talk about period pain!

What is period pain?

The technical term for period pain is dysmenorrhoea. It derives from an ancient Greek expression, which literally means ‘difficult monthly flow’.

Types of dysmenorrhoea:

1. Primary dysmenorrhoea commonly occurs in teenage girls and young women, at the beginning of their menstrual life. The pain usually gets better or even disappears completely within a few years of their first period. Many women also tend to have milder period pain after the birth of their first child. Cramping pains in this case are caused by the womb contracting to shed its lining and a decreased supply of blood to the womb. The pain is experienced mainly in the lower part of the abdomen but may also be felt in the back and down the front of the thighs.

2. Secondary dysmenorrhoea, however, doesn’t generally start until the mid-twenties or later and is unlikely to cease after childbirth. The pain is not restricted to the time of the menstrual bleeding but can occur throughout the cycle. Periods may become heavier and more prolonged, and intercourse may be painful. If you start to experience period pain as an adult you should consult your GP, as secondary dysmenorrhoea can be a sign of other conditions such as pelvic infections, which may need urgent attention.

What are the treatment options?

Over half of all women experience primary dysmenorrhea. Yet many consider their menstrual pain an inevitable consequence of being born a woman and therefore do not seek treatment.

When women do present to their GP with primary dysmenorrhea, the most commonly prescribed treatments are non-steroidal anti-inflammatory drugs (NSAIDs) and the combined oral contraceptive (COC) pill.

NSAIDs lower the production of prostaglandin and thereby relieve period pain. Contraceptive pills prevent ovulation, which reduces the amount of prostaglandin produced. This results in a thinner endometrial lining, and thus a lighter period.

Although NSAIDs are usually well tolerated, they sometimes have side effects, especially stomach-related issues. The contraceptive pill can have side effects such as headaches, nausea as well as an increased risk of thrombosis.

What are the alternatives?

Traditional Chinese medicine treatment options such as acupuncture and moxibustion, which consists of burning dried mugwort over a person’s skin, offer an alternative solution according to recent research.

A study conducted at The National Institute of Complementary Medicine at Western Sydney University found that acupuncture leads to a significant reduction in the intensity and duration of menstrual pain after three months of treatment, and that the results were sustained for one year after treatment. The likely mechanisms of action for acupuncture to improve primary dysmenorrhoea are endogenous opioid release, reduction of inflammation, and alterations in uterine blood flow, as well as changes in prostaglandin levels.

Furthermore, the women interviewed in this study overwhelmingly confirmed that empathy from practitioners, explanations about menstrual physiology, as well as advice on self-care, increased their self-efficacy and treatment outcome.

Another study investigating the efficacy of moxibustion in period pain found that pain levels decreased over the three-month trial, and that the therapeutic effect of moxibustion was sustained for three months after the trial ended. Blood tests indicated that moxibustion decreased levels of both PGF2 and PGE2, which allows for increased blood flow and decreased contractility of the uterus.

Heat application is well known for alleviating menstrual pain. “An abdominal heat wrap was found to be as effective as ibuprofen, and more effective than acetaminophen in relieving dysmenorrhea” [Proctor & Farquhar, 2006], and thus it is not surprising that the heat from moxibustion, especially when applied over the abdomen, is similarly effective for inducing vessel dilation and increasing blood flow to decrease pain.

Other simple ways to ease discomfort:

Wear loose-fitting clothing in the couple of days prior to and during your period.

Gentle exercise such as yoga may help.

A regular relaxation routine before your period is due, as well as on the first few days helps to relax the muscles and improves blood supply to the pelvic area.

Modifying your lifestyle can also ease period pain. So consider the following:

Stop or reduce smoking. Smoking is thought to increase the incidence of period pain by reducing the supply of oxygen to the pelvic area.

Reduce your alcohol consumption as alcohol may aggravate cramps and soreness for some women and can intensify PMS symptoms such as headaches, drowsiness, and fatigue.

Eat high fibre foods and plenty of salads and vegetables.

Daily vitamin E supplements have been shown to help.

Cut down on sugary foods and drinks, chocolate, cakes, and biscuits.

Reduce the amount of salt in your diet to avoid water retention.

What this shows is that menstrual pain is not inevitable. Many women may feel that medications are their only option for treating their monthly symptoms. But alternative options such as acupuncture and moxibustion have been shown to be equally effective. Furthermore, their effects have been proven to last long after the course of treatment. Also, educate yourself about your menstrual physiology and share your self-care advice with the women around you who also suffer from period pain.

Even if it’s uncomfortable, being a bit more up front and talking openly about your period pain may help reduce the stigma around menstruation as a whole.

About the author

Leela Klein

Leela is a qualified and registered Chinese medicine practitioner who is passionate about treating women’s health.